枸橼酸抗凝在脓毒症急性肾损伤患者血液滤过中的应用

Application of citrate anticoagulation in hemofiltration for patients with sepsis-induced acute kidney injury

目的比较局部枸橼酸抗凝(RCA)与全身肝素抗凝对脓毒症急性肾损伤(SAKI)患者早期行连续性肾脏替代治疗(CRRT)时滤器寿命及预后影响。方法确诊SAKI患者中选择90例KDIGO-Ⅰ期患者进行前瞻性研究,随机分为全身肝素抗凝组(A组,42例)及RCA组(B组,48例)。两组均予以CRRT治疗48 h,并监测CRRT治疗0、12、24、36、48 h时血肌酐(Cr)、血小板(PLT)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的变化。比较两组临床出血事件、滤器使用寿命,追踪28 d病死率。结果 CRRT治疗24、36、48 h时A组PLT值显著低于B组,差异均有统计学意义(P<0.01)。CRRT治疗12、24 h时A组IL-6值及TNF-α值均高于B组,差异均有统计学意义(P<0.05)。A组滤器寿命(25.90±7.66)h显著低于B组(37.80±5.72)h,差异有统计学意义(P<0.01)。B组出血发生率(2.08%)低于A组(16.67%),28 d病死率(20.83%)低于A组(45.24%),差异均有统计学意义(P<0.05)。结论 SAKI患者早期CRRT时使用RCA,与全身肝素抗凝比较,能显著延长滤器使用寿命,减少出血并发症,早期清除炎症介质,降低28 d病死率。

Objective To compare influence between regional citrate anticoagulation（RCA） and systemic heparin anticoagulation on filter life and prognosis in continuous renal replacement therapy（CRRT） for patients with sepsis-induced acute kidney injury（SAKI）. Methods A total of diagnosed 90 SAKI patients with KDIGO-Ⅰ stage in prospective study were randomly divided into systemic heparin anticoagulation group（group A, 42 cases） and RCA group（group B, 48 cases）. Both groups received CRRT treatment for 48 h, and their changes of serum creatinine（Cr）, platelets（PLT）, interleukin-6（IL-6）, and tumor necrosis factor-α（TNF-α） were monitored in 0, 12, 24, 36, 48 h in CRRT treatment. Comparisons were made on clinical bleeding events, filter life, and 28 d fatality rate between the two groups. Results Group A had obviously lower PLT value in 24, 36 and 48 h of treatment than group B, and their differences all had statistical significance（P〈0.01）. In 12 and 24 h of CRRT treatment, group A had all higher IL-6 and TNF-α value than group B. Their differences all had statistical significance（P〈0.05）. Group A had much lower filter life as（25.90±7.66） h than（37.80±5.72） h, and the difference had statistical significance（P〈0.01）. Group B had lower incidence of bleeding（2.08%） than group A（16.67%）, and its 28 d fatality rate（20.83%） was also lower than group A（45.24%）. The differences all had statistical significance（P〈0.05）. Conclusion Comparing with systemic heparin anticoagulation, implement of RCA in early CRRT for SAKI patients can prolong filter life, remove early inflammation medium, and reduce bleeding complications and 28 d fatality rate.